MCQs for bipolar disorder & depression

ASSESSMENT Of 30 mcqs

FPSC No : 46
MCQs on BIPOLAR DISORDER & DEPRESSION
Submission deadline : 9 December 2011

INSTRUCTIONS
• To submit answers to the following multiple choice questions, you are required to log on to the
College On-line Portal (www.cfps2online.org).
• Attempt ALL the following multiple choice questions.
• There is only ONE correct answer for each question.
• The answers should be submitted to the College of Family Physicians Singapore via the College
On-line Portal before the submission deadline stated above.

1. For patient education on bipolar disorder, X 5. In the recommended investigations claimable for
has prepared patient education booklets for monitoring the care of bipolar disorder, the use
distribution to all chronic disease management of X is an indication for ordering thyroid function
clinics in Singapore. What is X? tests (TFTs). What is X?
A. Health Promotion Board. A. Amitriptyline.
B. Ministry of Health. B. Respiridone.
C. College of Family Physicians, Singapore C. Lamotrigine.
D. Ministry of Community,Youth and Sports. D. Lithium.
E. Institute of Mental Health. E. Sodium valproate.

2. In the treatment algorithm for bipolar disorder,
6. About bipolar disorder, which of the following
the diagnosis of bipolar disorder is based on one of
information is CORRECT?
the following criteria. Which is CORRECT?
A. It affects 10 to 20 % of the Singapore population.
A. DSM III-TR criteria.
B. Onset of the condition is around 40 to 50 years old.
B. ICD 10 criteria.
C. The risk of relapse is as high as 50%.
C. ICD 9 criteria.
D. MOH criteria. D. One quarter of bipolar patients attempt suicide at least
E. IMH diagnostic criteria. once.
E. The illness cost from bipolar disorder in the United States
in the 1990s was 15.5 million US dollars.
3. The Clinical Global Impression (CGI) Scale has 2
items, one item to indicate severity and one item to
indicate improvement of the mental condition. Each 7. About factors in the assessment of suicide risk in
item has X points for the primary care physician to bipolar disorder, the presence of X identifies the
chose from. What is X? patient as a high risk patient. What is X?
A. 5.
A. Moral objection to suicide.
B. 6.
B. Social isolation.
C. 7.
C. History of impulsive behaviour.
D. 8.
D. Unemployment
E. 9.
E. Previous good coping and functioning.

4. In the recommended investigations claimable for

monitoring the care of bipolar disorder, the use of 8. A diagnosis of bipolar disorder can be missed or
X is an indication for ordering a renal panel (urea/ delayed by as long as 2 years. Which of the following
electrolytes/creatinine). What is X? is the most common reason?
A. Haloperidol. A. Symptoms are usually mild.
B. Respiridone. B. Presentation is usually late.
C. Lamotrigine. C. Misdiagnosed as unipolar depression.
D. Carbamazepine. D. Misdiagnosed as autism.
E. Sodium valproate. E. Misdiagnosed as hypothyroidism.

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MCQs for bipolar disorder & depression

9. About the behaviour associated with bipolar 14. About the comorbidity of depression, studies show
disorder, which of the following is most likely to that up to X% of patients with panic disorder or
occur at the hypomanic phase of the illness? obsessive compulsive disorder also have depression.
A. Financially spendthrift. What is X?
B. Sexually promiscuous. A. 20.
C. Overspeeding.
B. 25.
D. Outgoing and sociable.
C. 30.
E. Run-in with the law.
D. 35.
E. 40.

10. Pharmacological treatment is the cornerstone in
preventing relapses in bipolar disorder but poor
adherence is common. Which of the following 15. Madam Tan, aged 40, is not responding to the
factors is MOST likely to result in poor adherence treatment of her depression. You make the decision
to medications? to refer her to a psychiatrist. Which of the following
A. Personality disorder. be the LEAST helpful to encourage her to go and
B. Older age. see the psychiatrist?
C. Married. A. Demystify the psychiatric referral.
D. Infrequent professional exchanges between family physician B. Address the patient’s fears and concerns.
and the psychiatrist. C. Educate the patient on the service that can be expected.
E. Continuity of care.
D. Explain the emotional factors of the illness.

E. Tell her that her illness is serious.

11. About the prevalence of depression in Singapore
and worldwide, which of the following statement is
16. Major depressive disorder aggregates in families
CORRECT?
A. The lifetime prevalence of depression in the general and it is X times more common in individuals with
Singapore population is 25%. first degree biological relatives affected with this
B. About one-quarter of patients with major depression go disorder compared with the general population.
undetected in the primary care setting. What is X?
C. Major depression will become the leading cause of global A. 1.5 to 3.0
disease burden by 2020. B. 1.7 to 3.2.
D. In the primary care setting, about 10% of patients meet the C. 2.0 to 3.5.
criteria for major depression. D. 2.7 to 3.7
E. Depression is the third leading cause of long term E. 2.5 to 4.0
disability.

17. About the therapy for depression, the combination

12. About the diagnosis of depression in the primary
of X and medication is the most effective
care setting, which of the following is CORRECT?
combination. What is X?
A. Diagnosis of depression is easy in the teenage patient.
B. Life events being commonplace, are marginal triggers for A. Interpersonal therapy.
depression. B. Cognitive behavioural therapy (CBT).
C. Mild depression is easily recognized from the conversation C. Psychodynamic therapy.
with the patient. D. Behavioural therapy.
D. Overtly depressed mood is common in chronic illness. E. Supportive counseling.
E. Depression is often missed because they present with
somatic symptoms.
18. About behavioural therapy (BT), which of the
following is CORRECT?
13. About suicide related to depression which of the A. BT attempts to bring repressed thoughts and feelings into
following is CORRECT? consciousness and develop ways of tolerating and coping
A. The risk of suicide is present only when the person is acute
with the emotional pain.
depressed.
B. BT explores the links between depressed mood and a
B. Females are more common than males to have suicidal
severe life crisis.
thoughts.
C. Suicide is more likely if there are organized thoughts or C. Problem solving therapy is an example of BT.
plans on going about completing the act. D. The goal of BT is to break the self fulfilling prophecy of
D. Previous attempts at suicide marginally increases the risk of negative automatic thoughts.
suicide. E. BT concentrates on emotion focused solutions to
E. Divorce is no longer a risk for suicide. depressive thoughts.

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 MCQs for bipolar disorder & depression

19. About the antidepressants, they all have similarity 25. About the duration of treatment for major
in X. What is X? depressive disorder after remission is achieved,
A. Side-effect profiles. for the patient with a second episode of illness,
B. Drug-interactions. the duration of further treatment with the
C. Time of onset of action. antidepressant is X months without tapering the
D. Efficacy of 60-70% effectiveness. dose. What is X?
A. 3 to 6.
E. Take an average of 4-6 weeks to take effect.
B. 6 to 12.
C. 9 to 18
D. 12 to 24.
20. Antidepressants are classified into different E. 15 to 30.
classes depending on their biological action. Which
of the following is an example of noradrenergic
and specific serotonergic antidepressant? 26. In the assessment of an adolescent for a diagnosis
of bipolar disorder, which of the following raises
A. Dothiepin.
the likelihood of such a diagnosis?
B. Phenelzine.
A. Learning difficulty.
C. Duloxetine.
B. Presence of physical illness.
D. Bupropion.
C. A positive family history of mood disorders.
E. Mirtazepine. D. A difficult home environment.
E. A single parent family.

21. About the use of electroconvulsive therapy (ECT)

27. A 28-year-old Chinese patient is diagnosed to have
in bipolar disorder, which of the following is an
antenatal depression. Paroxetine is prescribed.
indication?
What of the following may occur in her child?
A. Prolonged manic episode.
A. Floppiness in the child.
B. Moderately severe depressive illness.
B. Cleft palate.
C. Hypomania. C. Persistent pulmonary hypertension in the newborn.
D. Agitated behaviour. D. Cardiac defects.
E. Apathy. E. Failure to thrive.

28. A 29-year-old mother is diagnosed to have postnatal

22. In bipolar disorder, which of the following is useful
depression. Her husband wants to know what is
in acute mania?
the local prevalence of this condition. Which of the
A. Bupropion. following is CORRECT?
B. Carbamazepine. A. 6.8%.
C. Imipramine. B. 5.8%.
D. Sertaline. C. 4.8%
E. Tranylcypromine. D. 3.8%.
E. 2.8%.

23. About inducing a manic episode or “switching”,

29. About the presentation of depression in the elderly
which of the following class of drugs is causative? patient, which of the following is CORRECT?
A. Benzodiazepines. A. Outright sadness is the usual presentation.
B. Atypical antipsychotics. B. Abrupt onset of cognitive impairment.
C. Antidepressants. C. Feelings of hopelessness is seldom encountered.
D. Mood stabilizers. D. Poor energy is a late clinical feature.
E. Typical antipsychotics. E. Self neglect is a late clinical feature.

30. About therapy of bipolar disorder in the elderly

24. About the antipsychotics in the management of patient, which of the following is CORRECT?
bipolar disorder, which of the following induces a A. Medication is not crucial for control of the condition.
metabolic syndrome? B. Lithium is not effective compared to case of the younger
A. Lamotrigine. patient.
B. Lithium. C. The refractory case may require electroconvulsive therapy.
C. Lorazepam. D. The starting dose of antidepressant should be low and
D. Olanzepine. upward titration should be then be rapid.
E. Sodium valproate. E. Psychotherapy has little place in this age group.

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